The straight dope on Italian health and medical care, from an American woman doctor who lives and works in Rome. Her memoir, Dottoressa, will be published in May 2019.

Tuesday, November 21, 2017

Abortion, Birth Rates, The New York Times

As the Italians say, it’s been
raining on wet ground. Following my recent blog entry on contraception in Italy
I received several emails from readers asking whether the rock-bottom Italian
birth rate might be the result of a sky-high abortion rate. By amazing
coincidence, two days later the New York Times published an article
about abortions in Italy and how hard it can be to get one. So the subject matter
of this post is overdetermined – I get to write a wonky post about abortions in
Italy at the same time as firing off a Letter to the Editor.

Amazingly, the Italian Parliament
legalized first-trimester abortion in public hospitals back in 1978, making it available
on demand and free of charge on the National Health Service. Three years later
a nominally Catholic electorate roundly scotched a Church-promoted national
referendum that tried to re-criminalize it. The Church retreated licking its
wounds but eventually hit on an excellent means of sabotage: conscientious
objection. The law’s option for gynecologists to refuse to participate was
originally intended to remain buried in the fine print but by now 70% of all Italian
gynecologists are registered as conscientious objectors. So waiting lists,
despite shrinking due to the increasing use of pills rather than surgery, are
still scandalously
long. One out of three women seeking a legal abortion is
given an appointment more than two weeks away, which drives many (20%, it’s
estimated) to get one illegally instead.

As the Times article points out,
it’s obvious that conscientious objection and Catholicism are related. But the
Church uses stronger weapons than mere moral persuasion in its promotion. I
explain in the letter I submitted (in vain) to The Times:

To The Editor,

In her otherwise excellent article, “Abortion in Italy, a Right Wronged,” Ilaria Maria Sala omits one crucial element
in why so many Italian gynecologists register as conscientious objectors. In
addition to the genuine religious convictions of some, and the fear of others
that performing abortions would tarnish their reputation, there are more
practical threats to their livelihoods. Abortions are performed only in public
hospitals, by gynecologists employed by the National Health Service. Many
public system gynecologists, however, want also to be able to treat their own
patients, after hours, within a large network of private hospitals which in
Italy are mostly owned and/or run by the Catholic Church. Any physician who
performs abortions – supposedly, any physician who even just counsels patients
about them – is barred from operating, delivering babies, or hospitalizing
patients in any Church-run institution. Thus a gynecologist who wants to be
able to work privately in Italy is virtually obliged to declare him- or herself
a conscientious objector to abortion.

So to get back to our original
question, do abortions have a big influence on Italian birth rates? Nope. Italy
has one of the lowest
abortion rates in western Europe. In proportion to the number of babies born
alive Swedish women have 40% more abortions than Italians, French women 35%,
English and Spanish about 18%. And only one in five abortions performed on
Italian women is a repeat procedure.

Since legalization there have been
fewer
and fewer abortions in Italy, especially among citizens – non-Italians,
many of them immigrants from developing countries, now account for one in
three.

The bottom line is that the Church
has indeed succeeded in mounting barriers to abortion, especially in southern Italy, but those barriers can be overcome. And women here don’t have to run the gauntlet of
demonstrators you find screaming abuse outside the entrances to abortion
clinics in the USA. And no one has ever shot an Italian abortionist.

One would think that it would not happen in the US— but I’m a gynecologist in a major town in Northern California with a population of over 70,000. The only hospital in town is a Catholic Hospital and anyone working for that Hospital not only cannot do abortions, but also cannot prescribe birth control or do sterilization procedures! How antiquated and anti-women! Luckily I am not employed by that hospital and they don’t bar doctors who DO perform those procedures from delivering babies in that hospital.

How astonishing! I had vaguely read that the Church was aggressively expanding its reach into control of health care and therefore reproductive rights in the US, but you've really brought it home for me. Keep up the good work. (Please pardon the late posting and reply - I've been on vacation truly without internet access.)

About Me

I moved to Rome in 1978 after finishing my training in New York, and have been practicing primary care internal medicine there ever since, treating a clientele that’s featured Roman auto mechanics and British ambassadors, Indonesian art restorers and Filipina maids, Russian poets and Ethiopian priests. When not seeing patients, doing research in psychosomatic medicine, or being the Artist's Wife to my composer husband, I've written a book about my medical adventures, Dottoressa: An American Doctor In Rome, to be published by Paul Dry Books in May 2019.